The roots of Panax ginseng C. A. Meyer, known as Korean ginseng have been a valuable and important folk medicine in the East Asian countries, such as China, Korea and Japan for about 2000 years. Panax is derived from a word ''panacea'', which means cure-all diseases and longevity as well as physical strength and resistance. As the use of traditional Chinese herbs as a food supply becomes more and more popular in the western countries, sales of Panax ginseng are increasing in North America and Europe as well as other parts of the world. Active constituents found in most ginseng species include ginsenosides, polysaccharides, peptides, polyacetylenic alcohols and fatty acids. Major active components in Panax ginseng are the ginsenosides, a group of saponins with triterpenoid dammarane structure. More than 30 ginsenosides have been isolated, and known compounds are identified but new compounds were elucidated. Pharmacological effects of ginseng have been demonstrated in cancer, diabetes mellitus, cardiovascular system, immune system and central nervous system including anti-stress and anti-oxidant activity. We have focused this review on the effect of ginseng on diabetes, anticancer activity and cardiovascular system and chemical structures of ginsenosides. In addition, our recent biological study on 20(S)-ginsenoside Rg 3 is also touched upon as follows. Multidrug resistance (MDR) has been a major problem in cancer chemotherapy. In this study in vitro and in vivo modulations of MDR by 20(S)-ginsenoside Rg 3 (Rg 3 ), a saponin characteristic of red ginseng, was investigated. In flow cytometric analysis using rhodamine 123 as an artificial substrate, Rg 3 promoted accumulation of rhodamine 123 in drug-resistant human fibrocarcinoma KBV 20C cells in a dose-dependent manner, but it had no effect on parental KB cells. Additionally Rg 3 inhibited [ 3 H]-vinblastine efflux and reversed MDR to DOX (doxorubicin), COL, VCR (vincristine) and VP-16 in KBV20C cells. Reverse transcriptase-polymerase chain reaction and immuno-blot analysis after exposure of KBV20C cells to Rg 3 showed that inhibition of drug efflux by Rg 3 was due to neither repression of MDR1 gene expression nor P-glycoprotein (Pgp) level. Photo-affinity labeling study with [ 3 H]-azidopine, however, revealed that Rg 3 competed with [ 3 H]-azidopine for binding to the Pgp demonstrating that G-Rg 3 competed with anticancer drug for binding to Pgp thereby blocking drug efflux. Furthermore, Rg 3 increased life span in mice implanted with DOXresistant murine leukemia P388 cells in vivo and inhibited body weight increase significantly. Further clinical trial of Rg 3 in reversal of Pgp-associated MDR is highly feasible.

Object An anterior approach for debridement and fusion with autologous bone graft has been recommended as the gold standard for surgical treatment of pyogenic spondylodiscitis. The use of anterior foreign body implants at the site of active infection is still a challenging procedure for spine surgeons. Several authors have recently introduced anterior grafting with titanium mesh cages instead of autologous bone strut in the treatment of spondylodiscitis. The authors present their experience of anterior fusion with 3 types of cages followed by posterior pedicle screw fixation. They also compare their results with the use of autologous iliac bone strut. Methods The authors retrospectively reviewed the cases of 60 patients with pyogenic spondylodiscitis treated by anterior debridement between January 2003 and April 2005. Fusion using either cages or iliac bone struts was performed during the same course of anesthesia followed by posterior fixation. Twenty-three patients underwent fusion with autologous iliac bone strut, and 37 patients underwent fusion with 1 of the 3 types of cages. Results The infections resolved in all patients, as noted by normalization of their erythrocyte sedimentation rates and C-reactive protein levels. Patients in both groups were evaluated in terms of their preoperative and postoperative clinical and imaging findings. Conclusions Single-stage anterior debridement and cage fusion followed by posterior pedicle screw fixation can be effective in the treatment of pyogenic spondylodiscitis. There was no difference in clinical and imaging outcomes between the strut group and cage group except for the subsidence rate. The subsidence rate was higher in the strut group than in the cage group. The duration until subsidence was also shorter in the strut group than in the cage group.

Two phenanthrenes were isolated from the aerial part of Dendrobium nobile Lindl. and their structures were identified to be 4,7-dihydroxy-2-methoxy-9,10-dihydrophenanthrene (1) and denbinobin (2), among which the former has been first isolated from this plant. These two compounds were found to be cytotoxic against A549 (human lung carcinoma), SK-OV-3 (human ovary adenocarcinoma), and HL-60 (human promyelocytic leukemia) cell lines. Compound 1 also showed antitumor activity on the life span of ICR mice intraperitoneally implanted with 1 x 10(6) cells of sarcoma 180.

A genuine glycoside, named ginsenoside Rh4, was isolated from Korean red ginseng (Panax ginseng C. A. Meyer) through repeated column chromatography, and its chemical structure was established to be 6-O-beta-D-glucopyranosyldammar-20(22),24-diene-3 beta,6 alpha,12 beta-triol by spectral and chemical methods. The stereochemistry of a double bond at C-20(22) of ginsenoside Rh4 was characterized as (E) from a NOESY experiment in the 1H-NMR of the aglycone. Cytotoxic activities of ginsenoside Rh4 and its aglycone against cancer cell lines were evaluated by use of the SRB method.

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